Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Comparative StudyThe impact of spontaneous ventilation on distribution of lung aeration in patients with acute respiratory distress syndrome: airway pressure release ventilation versus pressure support ventilation.
In this study, we sought to determine which mode, airway pressure release ventilation (APRV) or pressure support ventilation (PSV), decreases atelectasis more in patients with acute lung injury/acute respiratory distress syndrome (ARDS). ⋯ Spontaneous ventilation during APRV improves lung aeration by decreasing atelectasis. PSV for gas exchange is effective but not sufficient to improve lung aeration. These results indicate that APRV is more efficient than PSV as a mode of primary ventilatory support to decrease atelectasis in patients with ARDS.
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Anesthesia and analgesia · Dec 2009
Clinical TrialStroke volume variation during acute normovolemic hemodilution.
The intravascular volume of surgical patients should be optimized to avoid complications associated with both overhydration and underresuscitation. In patients undergoing intraoperative acute normovolemic hemodilution, we investigated whether stroke volume variation (SVV) derived from an arterial pressure-based cardiac output (CO) monitor system (FloTrac/Vigileo, Edwards Lifesciences, Irvine, CA) tracked the changes associated with blood removal and replacement. We further evaluated the correlations between SVV and 3-dimensional (3D) transesophageal echocardiographic (TEE) left ventricular (LV) volume measurements. ⋯ The SVV derived from the FloTrac/Vigileo system changes significantly as blood is removed and replaced during hemodilution. These changes correlate with 3D TEE measurements of LV volume. The utility of SVV in guiding optimization of intravascular volume merits further study.
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Anesthesia and analgesia · Dec 2009
Superficial cervical plexus neuropathy after single-injection interscalene brachial plexus block.
Interscalene brachial plexus block (ISB) using the modified lateral approach provides a well-established method of anesthesia and analgesia for patients undergoing shoulder surgery. Considering the neural anatomy at the site of injection, the superficial cervical plexus may be at risk of injury. We evaluated the incidence and characteristics of superficial cervical plexus neuropathy. ⋯ Superficial cervical plexus neuropathy is not uncommon after ISB using the modified lateral approach and the possibility should be discussed with patients preprocedurally.
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Anesthesia and analgesia · Dec 2009
Editorial CommentDifficult mask ventilation: what needs improvement?